Inequalities in Temporal Effects on Cervical Cancer Mortality in States in Different Geographic Regions of Brazil: An Ecological Study

Abstract

Cervical cancer is a public health issue with high disease burden and mortality in Brazil. The objectives of the present study were, firstly, to analyze age, period, and cohort effects on cervical cancer mortality in women 20 years old or older from 1980 to 2019 in the North, South, and Southeast Regions of Brazil; and secondly, to evaluate whether the implementation of a national screening program and the expansion of access to public health services impacted the examined period and reduced the risk of death compared with previous years and among younger cohorts. The effects were estimated by applying Poisson regression models with estimable functions. The highest mortality rate per 100,000 women was found in Amazonas (24.13), and the lowest in São Paulo (10.56). A positive gradient was obtained for death rates as women’s age increased. The states in the most developed regions (South and Southeast) showed a reduction in the risk of death in the period that followed the implementation of the screening program and in the cohort from the 1960s onwards. The North Region showed a decreased risk of death only in Amapá (2000–2004) and Tocantins (1995–2004; 2010–2019). The findings indicate that health inequities remain in Brazil and suggest that the health system has limitations in terms of decreasing mortality associated with this type of cancer in regions of lower socioeconomic development.

Desigualdades sociais no diagnóstico do câncer do colo do útero no Brasil: um estudo de base hospitalar

“…Esse padrão de distribuição e fragmentação da oferta resulta em iniquidades geográficas de acesso aos serviços de saúde no país 40,41 , o que contribui para os maiores percentuais de diagnóstico de câncer em estágio avançado nas mulheres residentes nas regiões Norte e Nordeste, em comparação com as moradoras do Sul e Sudeste 8,11 . Bem como contribui para a manutenção de tendência temporal ascendente, o aumento do risco de morte por câncer do colo do útero nos quinquênios dos anos 2000, com altas taxas de mortalidade nos estados Norte e Nordeste do Brasil, apresentando coeficientes semelhantes aos de países que não têm sistema de saúde universal e gratuito 42,43 .…”